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随着社会的进步和科技的飞跃,糖尿病的患病率正呈全球性地增长,致使许多国家,特别是发达国家用于治疗此病及其并发症的费用猛增,不堪重负。目前,全世界已把糖尿病视为最主要的公共卫生问题之一。本文就当前在糖尿病的防治研究方面的某些新进展作概要讨论。1　糖尿病前期的重要性1. 1　概念的提出　1997年美国糖尿病学会 (ADA)首次提出了“葡萄糖调节受损 (impairedglucoseregulation,IGR)”一词。它包括两方面的内容: (1)葡萄糖耐量减低 糖耐量受损(impairedglucosetolerance,IGT)。其定义为:空腹血糖<7 0mmol/L,OGTT2h血糖在 7 8…     

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维生素D缺乏所致的儿童佝偻病和成年后骨软化会促发并加重年老后发生的骨量减少或骨质疏松。因此,充足的维生素D是保证有效预防和治疗骨质疏松的基础。反映体内维生素D水平的最佳指标是血清25-羟维生素D[25(OH)D],其水平与骨密度、骨折风险和跌倒风险呈负相关。最优化的25(OH)D范围为30~50μg/L,20~<30μg/L为不足,低于20μg/L为缺乏。推荐老年人每天补充800~1000 U普通维生素D,骨质疏松患者、肥胖、缺乏日照和吸收不良的人可酌情增加至2000 U。     

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目的探讨急性脑卒中患者肺部感染的高发因素及并发肺部感染对预后的影响,寻求降低肺部感染率的方法。方法分析1996-2003年间上海同济大学附属同济医院神经内科急性脑卒中患者391例,采用卡方检验法分析肺部感染率与患者年龄、病种、病情、基础疾病及预后的关系。结果高龄、病情重、原有糖尿病、心脏病、肿瘤、免疫系统疾病及中风史患者,其肺部感染率明显升高,并发肺部感染的脑卒中患者病死率明显升高。结论控制院内肺部感染可有效提高脑卒中救治成功率。     

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??Abstract??Carotid artery dissection is a major cause of stroke??especially in young and middle-aged patients.A dissection is thought to result from trauma or can occur spontaneously.Many risk factors have been identified in association with carotid artery dissection such as hereditary factors??systemic arteriopathy??vascular anomaly??hypertension??migraine??trivial neck trauma??cervical spine manipulation and recent infection.Early recognition of these risk factors is favorable to prevention??diagnosis and management of the dissection.     

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??Abstract??Cerebral arterial dissection (CAD) has been recognized as one of the most common causes of ischemic stroke in young people??and it occurs when there is a tear in the intimal layer of the carotid or vertebral arteries with subsequent extravasation of blood into the subintimal layers.Clinical diagnosis is often difficult for the signs and symptoms vary and are similar to etiologies that are encountered far more frequently.But computed tomographic angiography??magnetic resonance angiography??and digital subtraction angiography may aid in diagnosis.Management options include antiplatelet therapy??anticoagulation??thrombolysis and endovascular procedures.With the progress of the diagnosis and treatment technologies in recent years??early recognition of dissection and timely medical intervention are clinically feasible??which can improve the cure rate and reduce morbidity and mortality of the stroke from CAD.     

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长期以来,关于急性脑卒中患者的血压是保持在高水平还是降至较低水平的问题一直存在争议。目前已有部分较大的循证医学证据支持脑卒中急性期降压治疗的获益,提示在急性缺血性或出血性卒中患者中积极降低血压是安全和有效的。但是,在那些重度急性脑卒中、颅内血流动力学不稳定患者中的降压仍需慎重,尚需大规模临床研究结果进一步证实。应在实际工作中根据患者的个体情况、综合分析降压过程的利弊。目前国内比较公认的意见是:血压>200/130 mmHg时开始降压治疗,24 h血压下降应<25%;溶栓前、溶栓后24 h内控制血压<185/110 mmHg。